Over a five month period the CAMHS ASD service implemented new ways of working to improve access and service user experience a number of changes to working practices.

• The assessment process has been streamlined to enable a more person centred and needs led service • Data has been used to set targets for the team and monitor progress month by month. • Technology has been used to film assessments that traditionally took two clinicians so one clinician can now carry out the assessment and review with colleagues in the multidisciplinary team case discussion. • Inter-team working and training within the directorate has upskilled more staff in detecting and screening ASD at the initial assessment stage.

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What We Did

Over a five month period the CAMHS ASD service implemented new ways of working to improve access and service user experience a number of changes to working practices.

• The assessment process has been streamlined to enable a more person centred and needs led service • Data has been used to set targets for the team and monitor progress month by month. • Technology has been used to film assessments that traditionally took two clinicians so one clinician can now carry out the assessment and review with colleagues in the multidisciplinary team case discussion. • Inter-team working and training within the directorate has upskilled more staff in detecting and screening ASD at the initial assessment stage.

The team have also raised awareness of ASD by: • Promoting ASD Awareness Days for the service Clinicians have adopted co-working and mentoring to further develop the wider staff group. Additional resource has also been available due to additional funding from the CCG

As a result the service has managed to reduce waiting times from 16 months to under 18 weeks for Autism Spectrum Disorder assessments for children and young people aged 0-18 years.

Wider Support

Increased collaboration with partner agencies (education, Paediatrics, SEND, Education Psychology, commissioning) has also been taking place over the past six months to develop a fully integrated pathway. The aim is to achieve a coordinated whole system approach.

We have supported colleagues in Tier 2 in developing a case for working in partnership, across the different organisational boundaries to potentially achieve early detection and minimise duplication for under-fives.

In addition, the team co designed a DVD with North Staffs Aspergers/ Autism Association (NSAAA) and young people who has used the service and been diagnosed with ASD. This DVD is given to parents/ carers and young people after diagnosis along with other information to highlight the positives of being on the ASD spectrum and reduce stigma.

Co-Production

The service regularly asks parents for feedback about their experiences of the service.

On completion of the assessment a draft report is sent to the parent to allow for feedback and comment before the final report is written

● Service user feedback in the form of patient, parent and clinician journeys have been used to improve the service alongside feedback questionnaires. ● Participation-a parent who had experienced the service joined an interview panel recently providing the carer perspective to recruitment and she continues to offer feedback on service improvement ● The Aston Leadership surveys on team effectiveness have been implemented and fed back. ● The team recently took part in a 360 degree feedback to the line manager and the rating were good for team engagement. ● Staff are encouraged to raise concerns at every team meeting and to put forward idea’s for service improvement. One idea which was clinician led was an ASD workshop which received excellent feedback from parents. The workshop included partner agencies – Education Psychology.

Looking Back/Challenges Overcome

It would be good to develop electronic resources for gathering our screening information as often there is inefficiency to waiting to receive screening packs back.

Having electronic forms parents can complete on-line would speed up the process and will be good to consider developing in the future. Colleagues in education would also welcome this innovation.

Sustainability

Whole service training has been offered to all staff on how to screen children and young people for ASD during initial assessments. 2. Specific skills training has been delivered to a targeted group of staff to increase the number of staff able to assess for ASD in the workforce. Staff have also been supported in co-working cases to build up expertise. 3. We have invested in training resources to enable any new staff to be skilled in the assessment measures used by the service.

Evaluation (Peer or Academic)

Our service has monitored waiting times on a weekly basis throughout the project period to enable us to constantly review the impact of the changes that we have made.

Outcomes

All children and young people referred to the service now receive an appointment within 18 weeks. We will continue to monitor feedback from families after assessments are complete.

Sharing

Within our directorate we are able to regularly share feedback on the project with colleagues. We are currently preparing a visual display for in our waiting areas for that is accessible to both children and parents to feedback the work that we have been doing.

Is there any other information you would like to share?

Towards the end of 2016 we have over 250 children and young people waiting approximately 16 months for an assessment for Autism Spectrum Disorder. As a team we came up with a number of strategies to reduce waiting times, including:

1. Providing screening tools to all staff within CAMHS to enable earlier recognition of appropriate referrals 2. Training to all staff on the new pathway and an ASD awareness session 3. Streamlining the service so that all referrals for ASD go through the HUB to be screened for risk and then into the teams to be screened if appropriate for assessment 4. Agreement that all telephone calls from parents on our waiting list to be taken by our referral HUB. This freed up clinical capacity in the team to offer more appointments per week 5. Advice given to all staff working at our central referral HUB as well as all team staff on relevant signposting information if responding to duty calls 6. Regular phone calls and letters to all families on the waiting list to enable us to prioritise where appropriate and to update records 7. Submission of a bid for additional funding, which was successful. This money was used to recruit a locum and to offer staff additional hours for a short period of time 8. Restructure to the psychological services input into the team to add an assistant psychologist to complete school observations, freeing up clinicians to offer more assessment appointments 9. Investment in training resources for completing ASD assessments so that we can train staff in-house 10. Development of a virtual team model in the 3 CAMHS teams whereby clinicians given additional ASD specific training and time allocation to offer a number of assessments each month 11. Consultation to a speech and language therapist employed through another Trust. This supported assessments being offered outside of our service by professionals already working to some of the preschool children referred to us 12. Liaison with colleagues in Educational Psychology and SENS regarding referrals into the team from their service to ensure no children were unnecessarily waiting 13. Shortening assessment reports 14. Changes to the assessment process to ensure play based assessments offered at the first appointment and the care plan developed depending on need. This reduced the number of extended parental interviews and school observations required 15. Weekly MDT meetings to enable all clinicians working in CAMHS to have a drop in opportunity to discuss cases 16. Use of video recording of assessment sessions to support MDT decision making As a result of these measures we are currently able to offer children and young people an assessment for ASD within 18 weeks of receiving a referral into our team.

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